Prevalence of Hemiplegic Shoulder Pain in Chronic Stroke Patients

Abstract

Background: Hemiplegic shoulder pain is a frequent and disabling complication of stroke that can persist into the chronic phase, adversely affecting upper-limb function, participation in daily activities, and overall quality of life. Despite its clinical importance, region-specific data integrating pain severity, functional disability, and objective shoulder mobility among chronic stroke survivors remain limited. Objective: To determine the prevalence and severity of hemiplegic shoulder pain in chronic stroke patients and to examine its association with shoulder-related disability and shoulder range of motion. Methods: A cross-sectional observational study was conducted among 160 adults with chronic stroke attending tertiary and secondary care hospitals in Faisalabad, Pakistan. Shoulder pain intensity was assessed using the Visual Analog Scale, functional disability using the Shoulder Pain and Disability Index, and active shoulder range of motion using goniometric measurement of flexion, extension, abduction, adduction, internal rotation, and external rotation on the hemiplegic side. Descriptive statistics summarized outcome distributions, and exploratory inferential analyses examined associations between pain severity and disability. Results: The mean Visual Analog Scale score was 3.85 ± 2.86, with 52.5% of participants reporting moderate-to-severe shoulder pain. The mean total Shoulder Pain and Disability Index score was 35.33% ± 25.85%, indicating moderate functional impairment, and 56.3% of patients had moderate-to-severe disability. Shoulder flexion and abduction were relatively preserved, whereas internal rotation (39.76°) and external rotation (37.55°) were most restricted. A significant linear trend was observed between increasing pain severity and higher disability levels. Conclusion: Hemiplegic shoulder pain remains highly prevalent in chronic stroke survivors and is associated with meaningful disability and disproportionate restriction of shoulder rotation. Routine standardized assessment and targeted rehabilitation strategies focusing on pain control and rotational mobility may improve long-term functional outcomes.